Floor Statements

Mr President, I am pleased to introduce with my colleague from Alabama, Senator Jones, the Taxpayer Identity Protection Act of 2018, a bill that seeks to help prevent American taxpayers and seniors from falling victim to identity theft and tax refund fraud.

As of May 17, the IRS had received more than 141.5 million individual income tax returns for the 2018 filing season. Of that number, nearly 75 percent were eligible for refunds. These refunds are not a gift from the Federal government--they are the return of funds belonging to taxpayers that were over-withheld from their paychecks last year. In the past few months, millions of American families have been eagerly awaiting these tax refunds, money they may need to pay off debts, medical bills, and plug gaps in the family budget. Unfortunately, for many Americans these refunds have not yet come.

Taxpayers are not the only ones eagerly awaiting these refunds. Criminals have figured out that, in many instances, it is cheaper and easier for them to steal taxpayers' identities and hijack their tax refunds than it is to traffic in drugs or rob banks.

Identity theft-refund fraud occurs when a criminal files a false tax return using a stolen Social Security Number and other sensitive personal information from sources like hospitals, schools, or assisted living facilities, often by recruiting employees to steal that information. The fraudster then uses this information to prepare fraudulent tax returns.

The thieves make sure to file early, as soon as the tax filing season opens in January, to increase the odds that they can get a refund before the real taxpayer files his or her return. The criminals are known to hold what they call ``make it rain parties,'' where they bring stolen laptops to a motel room with Internet access, and work together churning-out scores of fake returns.

These fraudsters work under the premise of ``file early, file often.'' Once the thieves file the fraudulent tax return, the IRS processes it and issues a refund. With each refund worth on average $2,778, the money can add up quickly.

This is not a victimless crime. Last year, the Federal Trade Commission received more than 371,000 complaints of identity theft, including 82,000 complaints related to employment or tax-refund fraud. Taxpayers who have their refunds hijacked by fraudsters often have to wait years to get the refunds to which they are legally entitled. Many are re-victimized year after year. A substantial number become victims of other forms of identity theft. Worst of all, victims are often the most vulnerable: elderly citizens who earn so little they are not even required to file a tax return. The IG estimates that 76,000 low-income elderly citizens were victims of tax-fraud identity theft in 2010 alone.

In 2016, the Lewiston Sun Journal published a story about a couple, Rick Zaccaro and his wife, Bonnie Washuk, who were victims of tax refund fraud. They had filed their taxes in late January 2015, and when Rick, a retired financial analyst for the Postal Service, was checking the status of their return online in early February, he learned that they were the victims of identity theft. Someone had filed and claimed a tax refund using their names, dates of birth, and Social Security Numbers. That claim was paid while their legitimate tax filing, with their appropriate W2s, was in limbo. It took months of worrying, frozen bank accounts, and a lot of calls to multiple government offices for them to try and straighten things out. When they did finally receive their refund, they also received something called an Identity Protection Personal Identification Number--better known as an IP PIN.

To provide relief to some victims of identity theft, the IRS began issuing IP PINs to eligible taxpayers in fiscal year 2011. An IP PIN is a six-digit number assigned to eligible taxpayers that allows their tax returns and refunds to be processed without delay and helps prevent the misuse of their Social Security Numbers on fraudulent income tax returns. If a return is e-filed with their Social Security Number and an incorrect or missing IP PIN, the IRS's system automatically rejects the tax return until it is submitted with the correct IP PIN or they file on paper. If the same conditions occur on a paper-filed return, the IRS will delay its processing and any refund that may be due while the IRS determines if the return actually belongs to the taxpayer.

In addition to victims of identity theft, in 2013, the IRS began a pilot

program in which it offered IP PINs to all taxpayers, not just those who were victims of identity theft, who filed their federal tax returns as residents of Florida, Georgia, or the District of Columbia. According to the IRS, these three locations have the highest per-capita percentage of tax-related identity theft in the country. Taxpayers in these three jurisdictions are not required to use an IP PIN but may opt-in to the program if they want the extra layer of identity protection.

In preparation for the 2018 Filing Season, the IRS issued nearly 3.5 million IP PINs to taxpayers, up from 770,000 in 2013. According to the IRS, as of February 28, 2018, it had rejected approximately 7,376 fraudulent e-filed tax returns, and as of March 15, 2018, it had stopped 1,442 paper-filed tax returns from posting to the Master File.

The Taxpayer Identity Protection Act of 2018 would expand and make permanent the IRS's IP PIN pilot program to help combat identity theft refund fraud across the nation. Specifically, our bill would authorize the IRS to incrementally expand its pilot program nationally, in phases, over a five-year period. Scaling out the program would give all taxpayers the opportunity to further protect themselves from falling victim to tax refund fraud and identity theft, while also saving taxpayers billions of dollars every year. The IP PIN pilot program has worked to protect against identity theft and the IRS supports its expansion over the next five-years. I urge my colleagues on both sides of the aisle to support the adoption of Taxpayer Identity Protection Act of 2018.

Mr. President, I rise to commend Agriculture Committee Chairman Roberts and Ranking Member Stabenow for their leadership in crafting a bipartisan farm bill that will help support our Nation's farmers and growers, provide funding for critical agriculture research programs, and make important investments in nutrition and food security programs.

It is an exciting time for agriculture in Maine. In fact, according to a recent study, Maine ranks first in the Nation for farming outlook, which considers factors such as farmer age, percentage of beginning farmers, and number of farms per 100 residents. According to the most recent Census data, the share of Maine farms owned and operated by farmers under the age of 45 is steadily growing. These factors show that Maine farms are poised for continued growth and long-term success.

The bill we have just passed includes a number of provisions from the Next Generation in Agriculture Act, which I introduced with Senator Heitkamp, including a reauthorization of the Beginning Farmer and Rancher Development Grant Program at a higher funding level. Since this program was established nearly a decade ago, it has supported more than 60,000 beginning farmers across every region of the country. In Maine, these grants have helped to build the capacity and skills of beginning farmers, as well as implement a dairy farmer apprenticeship program.

Maine's agricultural resurgence has also been bolstered by a rapidly expanding organic sector. According to the Maine Organic Farmers and Gardeners Association, Maine's organic agriculture sector has grown 76 percent over the past 5 years alone. In 2017, the association certified 535 farmers and producers representing more than 90,000 acres of farmland. The strong support for organic agriculture in this bill will help ensure that this sector continues its growth.

Federal investment in organic agriculture research, however, has not kept pace with the growth of organic producers. This bill incorporates legislation I introduced with Senator Casey that will increase funding for the Organic Agriculture Research and Extension Initiative, OREI. These additional resources will help ensure our farmers and producers benefit from the rising demand for organic products.

In addition to experiencing a resurgence in agriculture, Maine is also in the midst of reorienting its forest products industry following the downturn of traditional pulp and paper production in our State. I am encouraged to see that the bill supports innovative wood products research and development at institutions of higher learning. Based on provisions of the Timber Innovation Act, which I have cosponsored, the bill would authorize grants to advance the use of innovative wood products. Priority would be given to proposals that include the use or retrofitting of existing sawmill facilities with higher-than-average unemployment rates, which could be helpful to States such as Maine that are still recovering from the job losses from the closure of traditional mills.

An amendment that I sponsored with Senator Cantwell to direct the Forest Service to continue using remote sensing technologies when conducting forest inventory and analysis activities has also been incorporated. This technology is faster and less expensive thanphysically surveying plots of land and would enable the Forest Service to provide more accurate data to inform forest management decisions.

The bill also includes a number of provisions from the Local FARMS Act, legislation that I led with Senator Brown. One key provision provides mandatory funding for the Organic Certification Cost-Share Program, which helps to cover a portion of the costs associated with obtaining or renewing organic certifications.

Another component from our Local FARMS Act is the Local Agriculture Market Program, which will provide grants to support the development and expansion of direct producer-to-consumer marketing, as well as value-added agricultural products.

The bill also includes important provisions that help combat hunger, including the Local FARMS Act's establishment of a Harvesting Health pilot program through which fresh fruits and vegetables are provided to low-income individuals and households, as well as the reauthorization of the Seniors Farmers' Market Nutrition Program. The latter program is critically important for combating hunger among seniors and is complemented by the Farm Bill's reauthorization of the Commodity Supplemental Food Program, also known as the Senior Food Box Program. In an effort to help more seniors access and remain enrolled in the Senior Food Box Program, I am pleased that the bill includes a provision from legislation I authored with Senator Casey, the Nourishing Our Golden Years Act, which would allow States to establish a 3-year certification period for participants 60 years or older, effectively simplifying the process to provide this much-needed support.

The Specialty Crop Block Grant program that has been so vital for farmers and producers in my State is reauthorized for another 5 years. These grants support research and extension activities that address key challenges facing specialty crops, including Maine's iconic potatoes and lowbush blueberries, aiming to improve production efficiency, address threats from pests and diseases, more accurately prevent and monitor potential food safety hazards, and enhance crop characteristics.

The bill also makes important investments to support the export of U.S. agricultural products by reauthorizing both the Market Access Program, MAP, and the Foreign Market Development Program, which are critical to the success of Maine farmers and fishermen as they work to remain competitive in the global marketplace. According to the Maine International Trade Center, MAP has allowed Maine companies to expand their markets and

create more local jobs by facilitating the promotion and sale of Maine products like wild blueberries in the Middle East, maple syrup in Central Africa, and shellfish in the Far East.

As we continue to promote products such as maple syrup abroad, we must also ensure that we are not hindering their success here at home. Pure maple sugar producers in my state have expressed serious concerns with the ``added sugar'' requirements in the FDA's updated nutrition facts label rule. The rule would require the label to state that all sugar in the product is ``added sugar.'' While the FDA intended for the rule to help consumers make better-informed dietary choices, it is clear that the Agency's proposal instead creates confusion. Producers believe that the term ``added sugar,'' when used with a single- ingredient sweetener such as pure maple syrup or honey, implies the addition of another sugar like corn syrup.

I have raised this issue directly with FDA Commissioner Gottlieb, who is open to considering other approaches proposed by the industry, and have addressed it through language in the agriculture funding bill that directs FDA to evaluate alternate labeling proposals. Although I am encouraged to see that the FDA recently announced it would ``swiftly formulate a revised approach that makes key information available to consumers in a workable way,'' I have joined Senator King in offering an amendment to help ensure that this problem is rectified.

Another reasonable reform I am pleased to see included is sponsored by Senator Grassley. It closes a loophole allowing an unlimited number of passive ``managers'' to be designated by farm entities for the purpose of collecting farm subsidies. These subsidies are intended to support workers who are truly ``actively engaged.'' This provision will save an estimated $211 million, $100 million of which will be reallocated to The Emergency Food Assistance Program, TEFAP, which supports food pantries around the country.

It is a testament to the leadership of Chairman Roberts and Ranking Member Stabenow that they have produced a strongly bipartisan farm bill, and I am pleased to have supported it.

Mr. President, I rise today to introduce legislation with my colleague from Ohio, Senator Sherrod Brown, that would remove an unnecessary, outdated barrier for Medicare beneficiaries managing diabetes. Our legislation would allow physician assistants (PAs) and nurse practitioners (NPs) to satisfy the Medicare documentation requirement certifying a patient's need for therapeutic, or diabetic, shoes, which will improve access to care, reduce barriers to proper diabetic management, and help to reduce the prevalence of costly complications that can arise if diabetic symptoms are not managed properly. This bipartisan bill, the Promoting Access to Diabetic Shoes Act, is a companion to H.R. 1617 from my fellow Diabetes Caucus Co- Chair, Representative Tom Reed of New York, which has growing support on both sides of the aisle in the House.

As the founder and co-chair of the Senate Diabetes Caucus, I have worked since the very beginning of my Senate service to increase awareness of the threats posed by diabetes, invest in research, and improve access to treatment options for the over 30 million Americans, including twelve million seniors, who suffer from diabetes. In addition to the human toll, diabetes is also the most expensive chronic illness in the country. A new American Diabetes Association report released in March titled, ``Economic Costs of Diabetes in the U.S. in 2017,'' found that the direct and indirect costs of diagnosed diabetes in the U.S. cost $327 billion in 2017, which is a 26 percent increase in just the last five years.

Preventable complications contribute enormously to the influx of dollars being spent on diabetic care and

management. Today, more than one in five health care dollars and one in three Medicare dollars are spent on care for people with diabetes.

Under the current Medicare statute, physician assistants or nurse practitioners are required to refer their patients with diabetes to a physician in order to certify the patient's need for therapeutic shoes, which often results in delays in treatment and added costs. The Promoting Access to Diabetic Shoes Act would fix this problem by allowing nurse practitioners and physician assistants to certify a Medicare beneficiary's need for therapeutic shoes, which will improve timeliness and access to care while reducing costs.

Therapeutic shoes are a cost effective, preventive treatment option intended to avoid the costly complications that can arise if maintenance of diabetic care is delayed or unavailable. Types of complications that can result from unmanaged diabetic symptoms include poor circulation, infections, and foot ulcers that can require hospitalization, or even result in the amputation of toes, feet, or legs.

In addition to preventable complications and additional costs that can result from delays in treatment, the current documentation requirement under Medicare can also disrupt the trusted patient- provider relationship many patients have with an NP or PA. Current statute requires the certifying physician to be a patient's provider for diabetic care moving forward, which is often in conflict with a patient's preference. Moreover, in rural areas, including many parts of my home state of Maine, access to diabetic management though a PA or NP is not only necessary, but it is sometimes unavoidable due to the shortage of primary care providers in the area. Maine alone has 68 designated Health Professional Shortage Areas for primary care practitioners. These health care professionals are already providing accessible, high quality diabetic care across the country. In fact, a March 2018 article in the American Journal of Medicine concluded that PAs and NPs are able to perform as well as physicians in the management of diabetes at diagnosis through the first five years of follow-up care.

Stephanie Podolski, President of the Maine Association of Physician Assistants, which represents over 700 PAs in Maine, reiterated these points and the importance of the physician assistant profession in diabetes management in a letter of support for our bill saying, ``In a State like Maine, there are many rural communities that at times are served only by a PA as a primary care provider (PCP). The inability to order diabetic shoes is an outdated barrier to care that impacts both middle-aged and older Americans who frequently live in areas facing provider shortages.''

The Promoting Access to Diabetic Shoes Act is endorsed by the American Association of Nurse Practitioners, the American Academy of Physician Assistants, and the American Podiatric Medical Association. I am pleased to join Senator Brown in introducing the Promoting Access to Diabetic Shoes Act, which will improve access to diabetic care, and I encourage my colleagues to support its adoption.

Mr. President, I rise today to introduce legislation with my colleague from Ohio, Senator Sherrod Brown, that would remove an unnecessary, outdated barrier for Medicare beneficiaries managing diabetes. Our legislation would allow physician assistants (PAs) and nurse practitioners (NPs) to satisfy the Medicare documentation requirement certifying a patient's need for therapeutic, or diabetic, shoes, which will improve access to care, reduce barriers to proper diabetic management, and help to reduce the prevalence of costly complications that can arise if diabetic symptoms are not managed properly. This bipartisan bill, the Promoting Access to Diabetic Shoes Act, is a companion to H.R. 1617 from my fellow Diabetes Caucus Co- Chair, Representative Tom Reed of New York, which has growing support on both sides of the aisle in the House.

As the founder and co-chair of the Senate Diabetes Caucus, I have worked since the very beginning of my Senate service to increase awareness of the threats posed by diabetes, invest in research, and improve access to treatment options for the over 30 million Americans, including twelve million seniors, who suffer from diabetes. In addition to the human toll, diabetes is also the most expensive chronic illness in the country. A new American Diabetes Association report released in March titled, ``Economic Costs of Diabetes in the U.S. in 2017,'' found that the direct and indirect costs of diagnosed diabetes in the U.S. cost $327 billion in 2017, which is a 26 percent increase in just the last five years.

Preventable complications contribute enormously to the influx of dollars being spent on diabetic care and

management. Today, more than one in five health care dollars and one in three Medicare dollars are spent on care for people with diabetes.

Under the current Medicare statute, physician assistants or nurse practitioners are required to refer their patients with diabetes to a physician in order to certify the patient's need for therapeutic shoes, which often results in delays in treatment and added costs. The Promoting Access to Diabetic Shoes Act would fix this problem by allowing nurse practitioners and physician assistants to certify a Medicare beneficiary's need for therapeutic shoes, which will improve timeliness and access to care while reducing costs.

Therapeutic shoes are a cost effective, preventive treatment option intended to avoid the costly complications that can arise if maintenance of diabetic care is delayed or unavailable. Types of complications that can result from unmanaged diabetic symptoms include poor circulation, infections, and foot ulcers that can require hospitalization, or even result in the amputation of toes, feet, or legs.

In addition to preventable complications and additional costs that can result from delays in treatment, the current documentation requirement under Medicare can also disrupt the trusted patient- provider relationship many patients have with an NP or PA. Current statute requires the certifying physician to be a patient's provider for diabetic care moving forward, which is often in conflict with a patient's preference. Moreover, in rural areas, including many parts of my home state of Maine, access to diabetic management though a PA or NP is not only necessary, but it is sometimes unavoidable due to the shortage of primary care providers in the area. Maine alone has 68 designated Health Professional Shortage Areas for primary care practitioners. These health care professionals are already providing accessible, high quality diabetic care across the country. In fact, a March 2018 article in the American Journal of Medicine concluded that PAs and NPs are able to perform as well as physicians in the management of diabetes at diagnosis through the first five years of follow-up care.

Stephanie Podolski, President of the Maine Association of Physician Assistants, which represents over 700 PAs in Maine, reiterated these points and the importance of the physician assistant profession in diabetes management in a letter of support for our bill saying, ``In a State like Maine, there are many rural communities that at times are served only by a PA as a primary care provider (PCP). The inability to order diabetic shoes is an outdated barrier to care that impacts both middle-aged and older Americans who frequently live in areas facing provider shortages.''

The Promoting Access to Diabetic Shoes Act is endorsed by the American Association of Nurse Practitioners, the American Academy of Physician Assistants, and the American Podiatric Medical Association. I am pleased to join Senator Brown in introducing the Promoting Access to Diabetic Shoes Act, which will improve access to diabetic care, and I encourage my colleagues to support its adoption.

Mr. President, in 1993, American journalist and author John Wallach hosted a dinner with leaders from Israel, Egypt, and the Palestinian Authority. As he toasted his guests, he urged each country to send 15 youngsters to a new summer camp he had established in Otisfield, ME. That year, 46 teens, ages 13 to 18, and including three Americans, comprised the first class of the Seeds of Peace Camp.

Twenty-five years later, Seeds of Peace now has 6,698 alumni throughout the Middle East, South Asia, Europe, and the United States. They came to Maine from 27 countries, many from places of conflict, for 3 weeks of camping and social activities to promote understanding, reconciliation, acceptance, dialogue, coexistence, and peace. They returned home uniquely positioned to lead change and with the courage to dispel the fear, mistrust, and prejudice that fuel conflict.

It is a pleasure to congratulate this remarkable organization on its landmark 25th anniversary. Seeds of Peace is able to bridge borders and foster peace in the midst of longstanding global conflicts. Many of those early campers are now holding decisionmaking positions in their home countries, and I believe that the ``seeds of peace'' that were planted during their time in Maine will blossom into lasting, visionary solutions to conflicts perpetuated by cycles of violence.

Building on the success of the international program, Seeds of Peace launched the Maine Seeds leadership program in 2000 in response to the changing demographics in our State resulting from a growing refugee population. These Maine Seeds organize year-round community and school activities that bridge divisions and create positive change.

Seeds of Peace reveals the human face of youth who are too often exposed to hatred by engaging campers in both guided coexistence sessions and ordinary summer camp activities, such as sharing meals, canoeing, swimming, playing sports, and exploring creativity through the arts and computers. These interactions and the lasting friendships formed are creating new generations of leaders who will choose dialogue and understanding over violence and hatred.

In addition to the summer camp in Maine, Seeds of Peace provides year-round opportunities, through regional programming and the innovative use of technology, to enable former participants to build on the relationships forged at camp, so that the learning processes begun at camp may continue in the participants' home countries, where they are most needed.

Seeds of Peace is strongly supported by participating governments and many world leaders. Federal funding for Seeds of Peace demonstrates and recognizes the importance of Seeds of Peace in promoting the foreign policy goals of the United States.

The Seeds of Peace mission--to inspire and cultivate new generations of leaders to accelerate the social, economic, and political changes essential for peace--is more essential than ever before. From a small summer camp in Maine a quarter of a century ago to a global movement today, Seeds of Peace has carried out that vital mission and brought new hope to the world.

Mr. President, I rise today to introduce legislation, with my colleague from Pennsylvania, Senator Casey, that would reauthorize the only federally funded programs specifically designed to develop a health provider workforce to care for older Americans. The Geriatrics Workforce Improvement Act would reauthorize the Geriatrics Workforce Enhancement Program, known as GWEP, and also reinstate the Geriatric Academic Career Awards program, known as GACA.

The number of Americans aged 65 and older is growing rapidly. In Maine, we are reaching an aging milestone faster than other States--by 2020, the number of seniors is projected to outnumber children. This is 15 years aheadV the national projected date of 2035, at which point the number of Americans 65 and older will outnumber those under age 18 for the first time in U.S. history.

The United States is facing a critical shortage of geriatric health professionals and direct service workers to support our aging population. Today, we need 20,000 geriatricians; however, fewer than 7,300 of our Nation's nearly one million physicians are board-certified geriatricians. By 2030, we will need 3.1,000 geriatricians and even more geriatric health professionals and direct service workers. We need to train 1,600 geriatricians per year over the next 12 years to reach the targeted need by 2030.

As many as 90 percent of older adults are expected to have one or more chronic health conditions. Multiple chronic conditions, multiple medications, and changes that occur in aging make caring for older adults complex and challenging, yet also rewarding to healthcare professionals who choose this specialty. In any given year, it is expected that 30 percent of older adults and their families will require specialized geriatric care.

Today there are 44 geriatric workforce enhancement programs or GWEPs in 29 states. GWEP sites include 25 schools of medicine, ten schools of nursing, five healthcare facilities, two schools of allied health, a school of social work, and a certified nurse assistant program. GWEPs have the flexibility to tailor training in geriatrics to the unique needs of their own communities.

GWEP programs focus on Geriatric Education by:

1. Changing clinical training environments so that geriatrics is integrated into primary care delivery systems;

2. Training providers to assess and address the needs of older adults, their families, and caregivers at multiple levels within their communities;

3. Delivering community-based programs for patients, families and caregivers; and

4. Providing Alzheimer's disease education for families and caregivers, including direct care workers and other providers.

In 2016, the 44 GWEPs produced significant outcomes. They provided continuing education courses to 94,000 practicing public health professionals, from disciplines such as medicine, nursing, allied health, heath services administration, social work, and psychology. They have also created opportunities for healthcare providers in rural and underserved areas to learn from and consult with top experts in geriatric care through tele-consults, and educational webcasts, as well as online geriatric education programs that are publicly available and accessible online, 24 hours a day, 7 days a week, for free.

GACA programs focus on Resource Optimization. Established in 1998, GACA programs were funded to increase the number of faculty engaged in geriatric education. Transitioning from clinical training and practice into an academic faculty role is particularly challenging, and requires gaining new skills as an educator. These skills are not typically taught in clinical training programs.

Following a restructuring of the geriatric workforce program, GACA has gone unfunded since 2015. GACA would be reauthorized as a stand- alone resource within our legislation in order to optimize future growth and stability of early-career geriatric faculty. GACA supports early career development for emerging leaders by providing funding that supports 50 percent of their effort to develop skills as an inter- professional educator in geriatrics.

The Geriatrics Workforce Improvement Act would reauthorize the GWEP program at $45 million per year over the next five years, and reinstate GACA at $6 million per year. Together, these programs would train the current workforce and family caregivers, while simultaneously developing a cadre of emerging leaders in geriatric education, in a variety of disciplines. By doing both, we will assure that older Americans will be cared for by a health care workforce specifically trained to meet their unique and complex health needs for decades to come. This training to use the most efficient and effective methods for older adults will result in improved care while saving valuable resources, and reducing unnecessary costs.

Exposure to geriatrics, particularly through pre-clinical and clinical education, has been identified as an important factor for increasing interest in the field. This exposure provides faculty the opportunities needed to demonstrate the specialty is a viable, complex, yet rewarding specialty. The Geriatrics Workforce Improvement Act would provide these critical platforms by creating the infrastructure needed to attract the best and the brightest into the field of geriatrics.

This legislation already has broad support. I ask to enter into the record a letter of support from the National Association for Geriatric Education and the National Association of Geriatric Education Centers.

Mr. President. I urge my colleagues to support this bipartisan legislation that would ensure geriatric education for our current workforce, while optimizing resources to bolster academic careers in geriatrics. Together, GWEP and GACA would develop a high-quality geriatric workforce ready to provide care for Americans as we grow older.

National Association for Geriatric Education, National

Association of Geriatric Education Centers,

May 21, 2018.

Hon. Susan Collins,

Chair, Special Committee on Aging,

U.S. Senate, Washington, DC.

Hon. Bob Casey,

Ranking Member, Special Committee on Aging,

U.S. Senate, Washington, DC.

Dear Chairman Collins and Ranking Member Casey: On behalf

of the HRSA Title VII and Title VIII funded Geriatrics

Workforce Enhancement Programs (GWEPs) across the country,

thank you for your past support of geriatric education and

for introducing the Geriatrics Workforce Improvement Act. The

National Association for Geriatric Education (NAGE) is

pleased to offer our support for this important legislation,

which will reauthorize the GWEP and once again make the

Geriatrics Academic Career Award program (GACA) a part of the

effort

to prepare the geriatrics workforce for the aging of our

population. We and the growing numbers of older adults,

caregivers, and clinicians caring for elders will urge

Congress to move quickly to pass your bill and provide the

resources to address our nation's growing demand for

geriatric care.

We appreciate the many discussions that your staff

facilitated with NAGE, as well as with the Eldercare

Workforce Alliance, the American Geriatrics Society, and The

Gerontological Society of America during the process of

developing this legislation. This authorization and related

funding is needed for the development of a health care

workforce specifically trained to care for older adults and

to support their family caregivers. Currently there are only

44 GWEP sites in 29 states. The modest increase in the

authorization in your bill will have an important impact on

training in geriatric care. Likewise, the funds you have

authorized for the GACA program will assist in ensuring that

rural and underserved areas will have geriatrics education

programs.

NAGE is a non-profit membership organization representing

GWEP sites, Centers on Aging, and Geriatric Education Centers

that provide education and training to health professionals

in the areas of geriatrics and gerontology. Our mission is to

help America's healthcare workforce be better prepared to

render age-appropriate care to today's older Americans and

those of tomorrow.

Thank you for your continued support for geriatric

education programs.

Sincerely,

Maura Brennan, MD, FACP, AGSF, FAAHPM, CHMD,

President NAGE/NAGEC; Project Director, Baystate Health,

Geriatrics Workforce Enhancement Program; Chief, Div. of

Geriatrics, Palliative Care & Post-Acute Medicine; Prof. of

Medicine, Univ. of Massachusetts-Baystate; Adjunct Prof. of

Medicine, Tufts University School of Medicine.

Mr. President, I rise today to introduce legislation, with my colleague from Pennsylvania, Senator Casey, that would reauthorize the only federally funded programs specifically designed to develop a health provider workforce to care for older Americans. The Geriatrics Workforce Improvement Act would reauthorize the Geriatrics Workforce Enhancement Program, known as GWEP, and also reinstate the Geriatric Academic Career Awards program, known as GACA.

The number of Americans aged 65 and older is growing rapidly. In Maine, we are reaching an aging milestone faster than other States--by 2020, the number of seniors is projected to outnumber children. This is 15 years aheadV the national projected date of 2035, at which point the number of Americans 65 and older will outnumber those under age 18 for the first time in U.S. history.

The United States is facing a critical shortage of geriatric health professionals and direct service workers to support our aging population. Today, we need 20,000 geriatricians; however, fewer than 7,300 of our Nation's nearly one million physicians are board-certified geriatricians. By 2030, we will need 3.1,000 geriatricians and even more geriatric health professionals and direct service workers. We need to train 1,600 geriatricians per year over the next 12 years to reach the targeted need by 2030.

As many as 90 percent of older adults are expected to have one or more chronic health conditions. Multiple chronic conditions, multiple medications, and changes that occur in aging make caring for older adults complex and challenging, yet also rewarding to healthcare professionals who choose this specialty. In any given year, it is expected that 30 percent of older adults and their families will require specialized geriatric care.

Today there are 44 geriatric workforce enhancement programs or GWEPs in 29 states. GWEP sites include 25 schools of medicine, ten schools of nursing, five healthcare facilities, two schools of allied health, a school of social work, and a certified nurse assistant program. GWEPs have the flexibility to tailor training in geriatrics to the unique needs of their own communities.

GWEP programs focus on Geriatric Education by:

1. Changing clinical training environments so that geriatrics is integrated into primary care delivery systems;

2. Training providers to assess and address the needs of older adults, their families, and caregivers at multiple levels within their communities;

3. Delivering community-based programs for patients, families and caregivers; and

4. Providing Alzheimer's disease education for families and caregivers, including direct care workers and other providers.

In 2016, the 44 GWEPs produced significant outcomes. They provided continuing education courses to 94,000 practicing public health professionals, from disciplines such as medicine, nursing, allied health, heath services administration, social work, and psychology. They have also created opportunities for healthcare providers in rural and underserved areas to learn from and consult with top experts in geriatric care through tele-consults, and educational webcasts, as well as online geriatric education programs that are publicly available and accessible online, 24 hours a day, 7 days a week, for free.

GACA programs focus on Resource Optimization. Established in 1998, GACA programs were funded to increase the number of faculty engaged in geriatric education. Transitioning from clinical training and practice into an academic faculty role is particularly challenging, and requires gaining new skills as an educator. These skills are not typically taught in clinical training programs.

Following a restructuring of the geriatric workforce program, GACA has gone unfunded since 2015. GACA would be reauthorized as a stand- alone resource within our legislation in order to optimize future growth and stability of early-career geriatric faculty. GACA supports early career development for emerging leaders by providing funding that supports 50 percent of their effort to develop skills as an inter- professional educator in geriatrics.

The Geriatrics Workforce Improvement Act would reauthorize the GWEP program at $45 million per year over the next five years, and reinstate GACA at $6 million per year. Together, these programs would train the current workforce and family caregivers, while simultaneously developing a cadre of emerging leaders in geriatric education, in a variety of disciplines. By doing both, we will assure that older Americans will be cared for by a health care workforce specifically trained to meet their unique and complex health needs for decades to come. This training to use the most efficient and effective methods for older adults will result in improved care while saving valuable resources, and reducing unnecessary costs.

Exposure to geriatrics, particularly through pre-clinical and clinical education, has been identified as an important factor for increasing interest in the field. This exposure provides faculty the opportunities needed to demonstrate the specialty is a viable, complex, yet rewarding specialty. The Geriatrics Workforce Improvement Act would provide these critical platforms by creating the infrastructure needed to attract the best and the brightest into the field of geriatrics.

This legislation already has broad support. I ask to enter into the record a letter of support from the National Association for Geriatric Education and the National Association of Geriatric Education Centers.

Mr. President. I urge my colleagues to support this bipartisan legislation that would ensure geriatric education for our current workforce, while optimizing resources to bolster academic careers in geriatrics. Together, GWEP and GACA would develop a high-quality geriatric workforce ready to provide care for Americans as we grow older.

National Association for Geriatric Education, National

Association of Geriatric Education Centers,

May 21, 2018.

Hon. Susan Collins,

Chair, Special Committee on Aging,

U.S. Senate, Washington, DC.

Hon. Bob Casey,

Ranking Member, Special Committee on Aging,

U.S. Senate, Washington, DC.

Dear Chairman Collins and Ranking Member Casey: On behalf

of the HRSA Title VII and Title VIII funded Geriatrics

Workforce Enhancement Programs (GWEPs) across the country,

thank you for your past support of geriatric education and

for introducing the Geriatrics Workforce Improvement Act. The

National Association for Geriatric Education (NAGE) is

pleased to offer our support for this important legislation,

which will reauthorize the GWEP and once again make the

Geriatrics Academic Career Award program (GACA) a part of the

effort

to prepare the geriatrics workforce for the aging of our

population. We and the growing numbers of older adults,

caregivers, and clinicians caring for elders will urge

Congress to move quickly to pass your bill and provide the

resources to address our nation's growing demand for

geriatric care.

We appreciate the many discussions that your staff

facilitated with NAGE, as well as with the Eldercare

Workforce Alliance, the American Geriatrics Society, and The

Gerontological Society of America during the process of

developing this legislation. This authorization and related

funding is needed for the development of a health care

workforce specifically trained to care for older adults and

to support their family caregivers. Currently there are only

44 GWEP sites in 29 states. The modest increase in the

authorization in your bill will have an important impact on

training in geriatric care. Likewise, the funds you have

authorized for the GACA program will assist in ensuring that

rural and underserved areas will have geriatrics education

programs.

NAGE is a non-profit membership organization representing

GWEP sites, Centers on Aging, and Geriatric Education Centers

that provide education and training to health professionals

in the areas of geriatrics and gerontology. Our mission is to

help America's healthcare workforce be better prepared to

render age-appropriate care to today's older Americans and

those of tomorrow.

Thank you for your continued support for geriatric

education programs.

Sincerely,

Maura Brennan, MD, FACP, AGSF, FAAHPM, CHMD,

President NAGE/NAGEC; Project Director, Baystate Health,

Geriatrics Workforce Enhancement Program; Chief, Div. of

Geriatrics, Palliative Care & Post-Acute Medicine; Prof. of

Medicine, Univ. of Massachusetts-Baystate; Adjunct Prof. of

Medicine, Tufts University School of Medicine.

Mr. President, I rise today to express my support for the nomination of Gina Haspel to become the next Director of the Central Intelligence Agency. Ms. Haspel is an accomplished intelligence professional who will bring 33 years of experience to her new role. She has dedicated her entire life to the service of our country and has performed extraordinarily well in a number of challenging positions-- often, in some of the most dangerous places in the world.

Ms. Haspel has widespread support among the national security community. More than 50 leaders signed a bipartisan letter endorsing her nomination. The list includes eight former CIA Directors and Acting CIA Directors who were appointed by both Republican and Democratic Presidents, ranging from Ronald Reagan to Barack Obama. Michael Morell, a former CIA Acting Director under President Obama, describes her as a person of ``deep integrity,'' and John Brennan, another former CIA Director under President Obama, said she will provide ``unvarnished, apolitical, objective intelligence input to Donald Trump and others.''

At Ms. Haspel's hearing before the Senate Select Committee on Intelligence, I questioned Ms. Haspel regarding the enhanced interrogation program that was started after the September 11, 2001, terrorist attacks. I have long believed and have consistently stated that this program was completely unacceptable and that waterboarding is tantamount to torture. In fact, in 2015, I cosponsored the McCain- Feinstein amendment to the defense authorization bill to ensure that techniques such as waterboarding are never used again and that the Army Field Manual governs interrogations of detainees.

In response to my questions, Ms. Haspel, who was not a high-ranking CIA official at the time, indicated that she played no role in the creation of the interrogation program and that she wasn't even aware of its existence until more a year after it began. Furthermore, she said that she supported the 2015 law changes and made clear that she does not believe that the CIA should be in the ``interrogation business.'' She testified that, under her leadership, the CIA would follow the law and would not resume enhanced interrogations and that she would not seek to repeal the law.

Moreover, in a letter to the vice chairman of the Senate Select Committee on Intelligence, Senator Mark Warner, Ms. Haspel said that she would ``refuse to undertake any proposed activity'' that is contrary to her moral and ethical values, CIA's mission and expertise, or the law. ``The United States,'' she said, ``must be an example to the rest of the world'' and ``the enhanced interrogation program is not one the CIA should have undertaken.''

Another issue I closely examined was Ms. Haspel's role in the Agency's decision to destroy tapes involving one detainee who was subjected to enhanced interrogation. The accountability review from then-Acting Director Morell exonerated Ms. Haspel and stated conclusively that it was the CIA's then-Director of the National Clandestine Service who ordered the destruction of the tapes. As Mr. Morell, an Obama administration appointee, stated: ``Ms. Haspel did not destroy the tapes, she did not oversee the destruction of the tapes, and she did not order the destruction of the tapes.''

I will conclude by saying that it speaks very well of Ms. Haspel's nomination that she was reported favorably by a bipartisan majority of members on the Senate Select Committee on Intelligence, earning the support of both the chairman and vice chairman. I hope that Ms. Haspel will be confirmed quickly to be the next Director of the CIA, and I look forward to working with her in this new capacity to counter the wide range of national security challenges facing our country.

Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, I rise today in support of legislation I have introduced with several of my colleagues--Senators Murkowski, Barrasso, Stabenow, and Cassidy--that would remove a barrier that prevents patients from getting the most affordable prescription drug prices at the pharmacy counter.

Mr. President, Americans have the right to know which payment method--whether it is using insurance or paying with cash out of pocket--would provide the most savings when they are purchasing prescription drugs. The two bills we have introduced would establish some clarity in this incredibly opaque drug pricing system.

Nearly 60 percent of Americans, including roughly 90 percent of seniors, take at least one prescription drug. In 2016, Americans spent more than $330 billion, including a staggering $45 billion out of pocket, on retail prescription drugs. The Federal Government picked up another $139 billion through Medicare, Medicaid, and other programs.

Prescription drugs amount to nearly 18 percent of all healthcare expenditures and are the second fastest growing expenditure within healthcare. Moreover, two-thirds of personal bankruptcies in our country have been attributed to the cost of medical care, including prescription drugs. To make informed decisions, at the very least, we should have the right to know how much our prescription drugs cost.

At a series of hearings held by the Senate HELP Committee, I have questioned repeatedly one particularly egregious practice that conceals prices from patients at the pharmacy counter. This practice is the result of what are known as ``pharmacy gag clauses.'' These are contract terms

that prohibit pharmacists from proactively telling consumers if their prescription would actually cost less if they paid for it themselves rather than using their insurance plan. In other words, if the consumer is using insurance, pharmacists can actually be prohibited from disclosing whether the consumer is paying the lowest possible price. In fact, the pharmacist is prohibited from sharing this vital information unless the consumer explicitly asks.

Most consumers would never guess that it would be cheaper for them to pay out of pocket than to use their insurance plan to purchase the medicine they need. Insurance is intended to save consumers money in this situation, but that is not always the case. Gag clauses in contracts that prohibit pharmacists from telling patients how to obtain best prices obscure what the true cost of the drug could be and the fact that it could be lower than what the patient is paying. Several recent investigations, including by the New York Times and NBC News, have highlighted this unacceptable practice. For example, a consumer paid a copay of $43 for a cholesterol drug; however, had that same consumer paid cash rather than using his insurance, the cost would have been only $19. Another investigation told the story of a consumer who used insurance to pay $129 for a drug when the cost would have been just $18 had he paid out of pocket.

From Maine to California, the stories are endless. And this practice is not an outlier issue. According to a survey by the National Community Pharmacists Association, more than 50 percent of community pharmacists reported that gag clause restrictions prevented them from telling patients about other less expensive options, such as paying in cash, at least 10 times in the past month.

Recently, I was at the pharmacy counter at a grocery store in Maine, and the couple in front of me decided not to take the prescription they needed because the copay of $111 was more than they could afford. I could not help but wonder: If they hadn't used their insurance, would they have been able to purchase that drug at a lower price? It is so counterintuitive that very few consumers are going to think to ask the pharmacist that question.

I first learned about these gag clauses from pharmacists in Maine who were frustrated that they were prohibited from providing their patients with information on the most cost-effective way for them to purchase the medication they had been prescribed. Pharmacists are barred from speaking up, and those who do face penalties for doing so. Pharmacists are on the frontlines in helping patients manage multiple medications, and they would also like to help ensure that their patients are getting the best, most affordable price.

The first bill we have introduced, the Patient Right to Know Drug Prices Act, which is S. 2554--which I have cosponsored with the four Senators I mentioned, Senators McCaskill, Barrasso, Stabenow, and Cassidy--would prohibit pharmacy gag clauses in healthcare plans that are sold on the exchange and in group plans as well. The second bill, the Know the Lowest Price Act, which is S. 2553--which I am a lead cosponsor on with Senator Stabenow--would ban these clauses in Medicare Part D and Medicare Advantage plans.

Specifically, both bills would prohibit health insurance plans and any pharmacy benefit managers with whom they contract from restricting the ability of a pharmacist to provide a plan enrollee with information about any price difference that may exist between the price of the drug under the insurance plan and the price of the drug purchased out of pocket. Our bills would also prohibit penalties from being imposed on any pharmacist who shares such vital and valuable information.

Some States have already taken action to combat this problem. For example, the State of Maine enacted a law last year that prohibits charging an insurance enrollee a copayment or other charge that is higher than the cost of the drug to the pharmacy provider. The Maine law also protects pharmacists who disclose information related to out- of-pocket costs from being penalized by insurance companies or PPMs under gag clauses. These are commonsense solutions.

In announcing his drug pricing plan last week, the President, I am pleased to say, stated his intent to ban any gag clauses that would apply to pharmacies. While the administration can take some steps administratively to curb this practice, the enactment of our two bills would ensure that this protection for pharmacists and for patients is required under law.

As consumers continue to face skyrocketing prescription drug prices, we ought to do all we can to ensure that Americans are getting the best prices possible. As Congress looks at innovative ways to bring down prices and to increase transparency throughout the healthcare system, our bills tackle an overlooked issue that directly affects consumers and pharmacies across our country.

Our legislation has already received strong endorsements from more than a dozen organizations, including Patients for Affordable Drugs, the American Pharmacists Association, the Pharmaceutical Care Management Association, and other groups, ranging from the Arthritis Foundation to the AIDS Institute.

I ask unanimous consent that these letters and statements be printed in the Record at the conclusion of my remarks.

It is only logical that pharmacists want to be able to provide their customers with information that will help them afford the medications they have been prescribed. It is absolutely unacceptable for pharmacists in this country to be banned, under gag clauses, from providing that invaluable information to patients, particularly those who may be struggling with the cost of prescription drugs.

I urge my colleagues to support banning pharmacy gag clauses and the passage of both S. 2554 and S. 2553.

I yield the floor.

Mr. President, I wish to congratulate Dr. Susan J. Hunter, president of the University of Maine, on her retirement after 27 years of outstanding service in higher education. Dr. Hunter joined the faculty of the University of Maine at Orono in 1991 as a researcher in cell biology. In 2014, she was named the university's 20th president, the first woman to hold that position.

It is a pleasure to join the people of Maine in expressing gratitude for Dr. Hunter's commitment to higher education. In her many roles during a truly distinguished career--from researcher, to professor, provost, and president--she has been an inspiring leader.

Even if Dr. Hunter had remained solely in the research field, her contributions would be worthy of accolades. In addition to invaluable work in bone cell biology, she served as coprincipal investigator of an award-winning National Science Foundation grant that placed graduate teaching fellows in primary and secondary schools as science demonstrators. She also led the establishment of UMaine's Rising Tide Center, an important initiative to enhance opportunities for women faculty members in science, technology, engineering, mathematics, and social-behavioral sciences.

Dr. Hunter's service as an administrator includes chair of the department of biological sciences, associate provost and dean for undergraduate education, executive vice president for academic affairs and provost, and vice chancellor for academic affairs for the entire University of Maine System. Last year, while serving as president of UMaine's flagship campus at Orono, she also became president of the university's regional campus at Machias.

Dr. Hunter's leadership at UMaine played a key role in bringing about advancements in enrollment, fundraising, and advocacy and partnerships. During her presidency, UMaine has recruited its largest incoming classes and the largest number of out-of-state students in the university's 153-year history, and the university has seen a 22-percent increase in private giving to its annual fund. Students and supporters have expressed their confidence in Dr. Hunter's leadership in the most meaningful ways.

Dr. Hunter's contributions reach far beyond the campus. In the community, she has served on the boards of directors of the Maine School of Science and Mathematics, the Bangor Symphony Orchestra, and the Maine Mathematics and Science Alliance, and she worked with the Maine Arts Commission to develop a cultural strategic plan for the State of Maine. Currently, she serves on the boards of Maine & Company and the Maine Development Foundation to foster economic growth and job creation and on the advisory network for the Olympia Snowe Women's Leadership Institute.

Her achievements have been widely recognized. In 2016, Dr. Hunter was inducted into the Deborah Morton Society at the University of New England in honor of her work to advance women in scientific fields. Last year, she received the Wilma Award from the Collins Center for the Arts at the University of Maine for her promotion and enhancement of cultural activities and the Kenneth M. Curtis Leadership Award from the Maine Development Foundation for her commitment to economic opportunity.

In a recent interview, Dr. Hunter said that her leadership decisions have always been guided by the best interests of students and the people of Maine. Her decades of distinguished service and reverence for education have created a legacy that demonstrates how faithfully she has followed that guidance, and that will benefit our great State for many decades to come.

Mr, President, I rise today to introduce the Protecting Rational Incentives in Newsprint Trade Act of 2018, also known as the PRINT Act, which seeks to address an urgent crisis facing printers and publishers in the United States. I am very pleased to be joined by Senator King and a bipartisan and distinguished group of cosponsors, including Senators Blunt, Jones, Fischer, McCaskill, Moran, Wicker, Isakson, and Capito, to advance this legislation, which is endorsed by publishers representing more than 600,000 American jobs.

Earlier this year, the Department of Commerce instituted import taxes on certain types of paper imported by the U.S. printing and publishing industry from Canada. The paper--technically known as uncoated groundwood paper, but better known as newsprint--is used by newspapers, book publishers, and numerous other commercial printers in the United States. These import taxes are being advanced under the principle of trade enforcement to protect the domestic paper industry. It is telling, however, that nearly all of the U.S. paper industry opposes these import taxes, including the large trade association representing the entire industry, the American Forest and Paper Association. The paper industry opposes the import taxes because they threaten to decimate the paper industry's customers and drive printers and publishers out of business forever.

The import taxes are as high as 32 percent on some products. The printing and publishing industry is already facing a severe economic threat from the overall trends in the publishing market, including the shift to digital consumption of news. The printing and publishing industry simply cannot absorb the increased costs of paper caused by the tariffs. The Tampa Bay

Times, for example, has announced that the tariffs are increasing the newspaper's operating costs by $3 million annually and, as a result, it must lay off around 50 employees. Other newspapers across the Nation face the threat of layoffs and closures, particularly smaller publications and businesses serving local communities. The Swift County Monitor News in Benson, Minnesota, reported a 43 percent net increase in its newsprint costs from the duties. But let's not forget the impact of these tariffs on such an important profession in our society. The Executive Editor of the Lewiston Sun-Journal and seven Western Maine weekly newspapers put it this way: ``While tariffs are going to cost the newspapers in real dollars, the real cost will be to the mission of journalists and the ability of newspapers--of all sizes--to carry on critical work in the public interest.''

Mr. President, I strongly support the robust enforcement of our trade laws to protect U.S. interests, but these new import taxes are having the opposite effect. The import tariffs are dramatically increasing costs for publishers, accelerating the decline of local and regional papers across the Nation, and undermining the United States paper industry's customer base without any chance of recovery.

I trust that the Department of Commerce has accurately applied the trade enforcement remedies in this case, but that is exactly the problem. The antidumping and countervailing duty trade remedies are not equipped to address a situation like this where the import duties will actually harm the industry they were intended to protect.

That is the reason that we are introducing the PRINT Act. Our bill would suspend the import taxes on this paper while the Department of Commerce examines the health of--and effects on--the printing and publishing industry. It is important to note that the legislation does not propose that Congress step in and substitute its judgment. The President would retain full authority to implement the duties after the Commerce Department completes its study.

Moreover, the legislation is only a pause. It is designed to ensure that the government makes decisions about these import tariffs with an understanding of all the anticipated and potential collateral effects on the U.S. industry and jobs.

Mr. President, this bill is both sensible and urgently needed. Printers and publishers throughout the country have indicated that the import taxes are threatening irreparable harm to their businesses. Adoption of the PRINT Act would ensure that we evaluate fully the impact of these tariffs before the duties kill American jobs for good. I encourage my colleagues to join me in supporting this important legislation.

Mr, President, I rise today to introduce the Protecting Rational Incentives in Newsprint Trade Act of 2018, also known as the PRINT Act, which seeks to address an urgent crisis facing printers and publishers in the United States. I am very pleased to be joined by Senator King and a bipartisan and distinguished group of cosponsors, including Senators Blunt, Jones, Fischer, McCaskill, Moran, Wicker, Isakson, and Capito, to advance this legislation, which is endorsed by publishers representing more than 600,000 American jobs.

Earlier this year, the Department of Commerce instituted import taxes on certain types of paper imported by the U.S. printing and publishing industry from Canada. The paper--technically known as uncoated groundwood paper, but better known as newsprint--is used by newspapers, book publishers, and numerous other commercial printers in the United States. These import taxes are being advanced under the principle of trade enforcement to protect the domestic paper industry. It is telling, however, that nearly all of the U.S. paper industry opposes these import taxes, including the large trade association representing the entire industry, the American Forest and Paper Association. The paper industry opposes the import taxes because they threaten to decimate the paper industry's customers and drive printers and publishers out of business forever.

The import taxes are as high as 32 percent on some products. The printing and publishing industry is already facing a severe economic threat from the overall trends in the publishing market, including the shift to digital consumption of news. The printing and publishing industry simply cannot absorb the increased costs of paper caused by the tariffs. The Tampa Bay

Times, for example, has announced that the tariffs are increasing the newspaper's operating costs by $3 million annually and, as a result, it must lay off around 50 employees. Other newspapers across the Nation face the threat of layoffs and closures, particularly smaller publications and businesses serving local communities. The Swift County Monitor News in Benson, Minnesota, reported a 43 percent net increase in its newsprint costs from the duties. But let's not forget the impact of these tariffs on such an important profession in our society. The Executive Editor of the Lewiston Sun-Journal and seven Western Maine weekly newspapers put it this way: ``While tariffs are going to cost the newspapers in real dollars, the real cost will be to the mission of journalists and the ability of newspapers--of all sizes--to carry on critical work in the public interest.''

Mr. President, I strongly support the robust enforcement of our trade laws to protect U.S. interests, but these new import taxes are having the opposite effect. The import tariffs are dramatically increasing costs for publishers, accelerating the decline of local and regional papers across the Nation, and undermining the United States paper industry's customer base without any chance of recovery.

I trust that the Department of Commerce has accurately applied the trade enforcement remedies in this case, but that is exactly the problem. The antidumping and countervailing duty trade remedies are not equipped to address a situation like this where the import duties will actually harm the industry they were intended to protect.

That is the reason that we are introducing the PRINT Act. Our bill would suspend the import taxes on this paper while the Department of Commerce examines the health of--and effects on--the printing and publishing industry. It is important to note that the legislation does not propose that Congress step in and substitute its judgment. The President would retain full authority to implement the duties after the Commerce Department completes its study.

Moreover, the legislation is only a pause. It is designed to ensure that the government makes decisions about these import tariffs with an understanding of all the anticipated and potential collateral effects on the U.S. industry and jobs.

Mr. President, this bill is both sensible and urgently needed. Printers and publishers throughout the country have indicated that the import taxes are threatening irreparable harm to their businesses. Adoption of the PRINT Act would ensure that we evaluate fully the impact of these tariffs before the duties kill American jobs for good. I encourage my colleagues to join me in supporting this important legislation.

Madam President, this week I cast my vote in support of the nomination of Kyle Duncan to serve as a judge on the Fifth Circuit Court of Appeals. Mr. Duncan has been a successful trial and appellate attorney, as well as a law professor at the University of Mississippi School of Law. He was the assistant solicitor general for the State of Texas and the appellate chief for the State of Louisiana. He has tried cases at the State and Federal levels and has argued twice before the U.S. Supreme Court. The American Bar Association has reviewed his nomination and has rated Mr. Duncan ``well-qualified.''

Some have criticized Mr. Duncan for his work on certain high-profile cases. Nearly all nominees for the Federal courts who come before the Senate have advocated for various positions. Some of them have been involved in controversial, high-profile cases. In considering a nominee's fitness to serve on the bench, we should consider whether they have the intellect, the temperament, and the respect for precedent to fairly and faithfully uphold the law.

One case that Mr. Duncan litigated has been mischaracterized in a way that suggests he is biased against the LGBT community. Mr. Duncan's opponents argue that his work in V.L. v. E.L., in which the opposing party was a lesbian, demonstrates this bias. What these critics fail to mention is that Mr. Duncan's client was also a lesbian. The matter was a custody case involving two women in a same-sex partnership. As his cocounsel in the case, Randall W. Nichols, has described in a letter to the Senate Judiciary Committee, dated November 27, 2017:

I note that some may criticize Mr. Duncan for representing

clients in the same-sex marriage litigation. It must not go

without notice that our mutual client, E.L., was a same-sex

woman asserting a strong, albeit ultimately unsuccessful,

legal argument. Mr. Duncan represented our mutual client

without once making an issue of her sexual orientation,

without once displaying any personal bias, and without once

indicating a desire to advance any agenda other than winning

the case for E.L.

Mr. Duncan has testified to the Judiciary Committee that he would follow all applicable precedents of the Supreme Court and Fifth Circuit. He demonstrated his deference to precedent during his time representing the State of Louisiana. While the Supreme Court was deciding the Obergefell case on the constitutionality of same-sex marriage laws, Mr. Duncan was representing the State of Louisiana in a challenge to its marriage law. Following the Court's decision, the Fifth Circuit instructed the parties in the Louisiana case to explain whether Obergefell resolved the matter for the court.

The very next day, Mr. Duncan filed a letter explaining that, despite Louisiana's disagreement with the Obergefell outcome, the Fifth Circuit must follow the new Supreme Court precedent and strike down Louisiana's law. While still representing the State, Mr. Duncan announced that married same-sex couples would be able to have both of their names on their children's birth certificates. Mr. Duncan's actions following the Obergefell decision demonstrate that he will respect precedent and faithfully follow the law.

By contrast, in a similar case, the lawyers for the State of Arkansas continued to fight over whether Obergefell required States to issue birth certificates with the names of both same-sex spouses. Unlike Mr. Duncan, they resisted the Obergefell precedent all the way up to the Supreme Court and lost. That case, Pavan v. Smith, confirms that Mr. Duncan did the right thing in advising the Fifth Circuit to apply the Obergefell precedent.

It is also noteworthy that the attorney who argued against Mr. Duncan in the Louisiana case strongly supports his nomination. In an opinion article published in ``The Hill'' on March 25, 2018, Paul Baier, who is now a law professor at Louisiana State University, describes Mr. Duncan as a ``magnificent nominee for the Fifth Circuit who ought to be swiftly confirmed.'' He goes on to describe Mr. Duncan's qualifications in the following way:

I always appreciated and respected Kyle's advocacy for his

client and his respect for the humanity of the same-sex

couples who would be most affected by the case. While I

disagreed with many of his arguments, often emphatically, I

never found a trace of bias, bigotry, or any disrespect

towards the same-sex individuals in the case.

Kyle knows well the difference between the advocate's role

for his client (in the same-sex marriage case, the State of

Louisiana) and what he would be called upon to decide as a

judge on the Fifth Circuit. I maintain this view of Kyle even

having faced off against him in the highly charged atmosphere

of same-sex marriage litigation. His ability to act as a

judge and not advocate will surely carry over to other

questions of public importance facing the Fifth Circuit.

The advice and consent role given to the Senate in the Constitution is one of

the Senate's most solemn duties and one to which I give the utmost care. I apply no litmus test with respect to a nominee's personal beliefs, and have voted for judicial nominees whose personal views differ from my own, but evaluating whether a nominee possesses an ability to set aside emotion and personal views while applying the laws in a neutral and impartial manner is critical.

In this regard, I believe Mr. Duncan will be faithful to the rule of law. He has pledged to the Judiciary Committee and to me that he will follow all precedents of the Supreme Court, and his actions in the Louisiana same-sex marriage case are evidence that he will do this, even if he disagrees with the outcome. I support his confirmation.

Mr. President, I thank the Senator from Delaware for allowing me to speak for up to 12 minutes.